Reports from State health officers and from the zones surrounding Army camps indicate that there has not been any decided general change in the prevalence of influenza in the United States. In Louisiana a recrudescence of the disease is reported from a number of places, and in California the disease appears to be increasing in most communities.

The reports from States for the week ended January 11, 1919, as compared with the preceding week, show increases in the number of cases reported from Arkansas, California, Florida, Indiana, Kansas, Louisiana, Massachusetts, Oregon, and Washington.

Decreases in the number of cases reported are noted in Connecticut, Maine, Michigan, New Jersey, North Carolina, Vermont, and Virginia. pp. 80 and 84 of this issue of the Public Health Reports.)

(See

RESOLUTIONS PASSED BY NATIONAL COMMISSION ON MILK STANDARDS.

(Meeting held in Chicago, Ill., Dec. 8, 1918.]

The National Commission on Milk Standards appointed by the New York milk committee has received from its members reports concerning the prices paid for milk to the producer and the prices at which milk is sold to the consumer, the quantity of milk sold, and the mortality statistics from localities represented by members of the commission, including Boston, New York, Philadelphia, Wilmington, Baltimore, Toronto, Indianapolis, Chicago, Jacksonville, and others, and it is the judgment of the commission

(1) That the price of milk to the consumer from 1914 to 1918 has in general increased from 50 to 100 per cent.

(2) That while the quantity of milk consumed has fluctuated in the cities from which reports have been received, yet generally at the present time it is not less than the normal or usual supply.

(3) That there has been an improvement in infant mortality and a lessening in diarrheal diseases under 2 years of age and that this improvement has not been checked by the advance in the price of milk between 1914 and 1918.

(4) That evidence presented to the commission indicates the seriousness of undernourishment or malnutrition among children of school age. The commission believes that the cause of this is an improperly regulated diet due to some extent to poverty and to a larger extent to lack of appreciation of the value of milk as compared with other foods.

(5) That the proportionate increase in the price of other foods generally has been greater than the increase in the price of milk.

(6) That at present retail prices milk is the most economical animal food that can be purchased.

(7) The commission recognized that the results of nutrition investigations during the past 10 years have demonstrated that satisfactory nutrition is to be secured only through the employment of certain combinations of foods. It recognizes that milk, eggs, and green leafy vegetables are so constituted as to correct, when taken in liberal amounts, the deficiencies from the dietary standpoint of cereal products, peas, beans, tubers, edible roots, and meats. Since good nutrition can not be secured on diets from which milk, eggs and the leafy vegetables are absent, it is of the greatest importance that the use of these classes of foods should be extended.

It is further recognized that among these milk is the most effective and most economical and that milk is the one food for which there is no satisfactory substitute.

The commission received reports of special tests made in many municipal and private laboratories on 100 samples of milk taken from the same quart bottle by the standard methods for determining the numbers of bacteria in milk recommended by the laboratory section of the American Public Health Association, and basing its opinion on these and previous reports the commission passed the following resolution:

"The commission believes that experience has shown that the present standard methods of the laboratory section of the A. P. H. A., for making the bacterial test of milk in the hands of properly trained workers are satisfactory for the control of the sanitary character of raw milk on the efficiency of pasteurizing machines for destroying bacteria, and for the enforcement of regulations for milk control by such grades and standards as have been recommended by this commission."

The use of powdered whole milk, skim milk powder, condensed or evaporated whole milk or skim milk, butter fat or other fats and water and of machines for recombining, mixing, or emulsifying these materials for the production of manufactured milk or cream was

considered by a special committee including some of the food chemists of the commission. Their special report on these subjects was adopted by the commission and was as follows:

"Since the application of the term 'synthetic' to mixtures such as those under consideration is not entirely consistent with the accepted scientific use of the term and is likely to cause confusion, we recommend that the use of the term 'synthetic' be discouraged and that the commission recommend the terms 'recombined milk' 'reconstituted milk,' on the labels of products made entirely from milk constituents and 'artifical milk' or 'milk substitute' on the labels of products in which any other fat is substituted in whole or in part for milk fat. Products which do not contain the proteins and mineral elements of milk should not be entitled to the use of any designation of which the word milk is a part.

2. The committee moves the adoption of the following resolution: "Whereas recent investigations in the science of nutrition have fully demonstrated the unique value of milk as a food and the intimate relation between adequate milk consumption and the support of normal growth or maintenance of health and vigor: Be it

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Resolved, That the commission urge upon all concerned with the production and distribution of milk, whether as producers, deal-' ers, or public health and food control officials, the great importance of bringing into human consumption the largest possible proportion of all wholesome milk products, and to this end recommends that the sale of such products as recombined milk should not be hampered by any restrictions beyond those absolutely necessary for the prevention of fraud and the protection of health.'

3. In the case of recombined milk made exclusively from cream or butter and milk or skim milk, fresh, condensed or dried, the materials having always been maintained in sound condition and not subjected to unnecessary heating, the interests of the consumer in our opinion demand nothing further than that the product as delivered to the purchaser shall meet all the requirements as to cleanliness, bacteria count, and chemical composition of fresh milk of the same grade or class, and shall be labeled in a manner that will correctly indicate its true character."

MENTAL HYGIENE A PUBLIC HEALTH ACTIVITY.

As is so often the case with other chronic illnesses, e. g., tuberculosis, malaria, Bright's disease, it is difficult to rouse the people to an appreciation of the need of taking steps to combat and control mental disease. To a large extent, to be sure, this is due to the persistence of the belief that mental disorders are a kind of a mysterious dispensation, and that little or nothing can be done either to effect a cure of those affected, or to prevent the development of these dread disorders.

Continuing the comparison with other chronic diseases, it may be pointed out that only in recent years has the fact become established that a very large proportion of the mentally ill have hitherto escaped

recognition. Early signs and symptoms of mental disorder have been overlooked, and the diagnosis of "insanity" has often been established only when it was too late to effect a cure. To be sure we have by no means reached the stage where all forms of mental disease are curable. Nevertheless sufficient is known to assure a considerable reduction in the prevalence of mental disorders provided certain practicable measures are taken.

At the present time, institutional care is generally provided only for the more pronounced types of mental disorders. According to the United States Census Bureau there were, in 1910, 187,791 persons in hospitals for the insane and 20,731 persons in institutions for the feeble-minded. While this gives some idea of the number of mental cases cared for in institutions specially provided for them, it must be remembered that it does not represent the total number of cases in this country, as many such individuals who are in need of institutional care never receive it. It has been calculated that the aggregate cost to the country of the insane alone is more than $160,000,000 annually. Added to this, and really more serious, are the personal suffering, unhappiness, social and family disasters, and business troubles brought about by mental disease.

On the basis of the lowest estimates there are two insane and four feeble-minded individuals for every 1,000 persons in the general population of the United States. Field investigations by officers of the United States Public Health Service indicate that in school children the ratio of feeble-minded will average eight per thousand.

The medical examinations of registrants in the first selective draft showed that out of each 1,000 men examined, 24 were denied military duty because of nervous or mental disorders. Other cases were unrecognized or developed under stress of military training and warfare, necessitating their return home.

Many of those who comprise the dependent and criminal population suffer from some type of mental disorder, either acquired or hereditary, and this disorder often constitutes the underlying cause of their dependency or imprisonment. Of the 84,198 persons confined in almshouses in 1910, at least 42,000 had some form of mental alienation; of the 136,472 persons in prisons, jails, workhouses, and institutions for juvenile delinquents at least 30,000 were mentally diseased. This gives some idea of the relation of mental disease to dependency

and crime.

It is high time for physicians and health officers to take an active interest in mental disease as a public-health problem. Early recognition of the signs and symptoms of mental disorder, attention to the various causative factors (social, family, occupational, hereditary, infectious), provision for the proper care of the mentally illthese represent a practicable program which is certain to achieve satisfactory results.